Cataract

Purpose: Capsular block syndrome of late onset is one of rare post-operative complications of cataract surgery. Here we report the diagnosis and successful surgical management of this case. Case report: A 70 year aged person presented with gradual decrease of right eye vision for 4 years with a history of phacoemulsification surgery which was done 8 years back. Patient’s presenting vision was 6/60 in right eye with a whitish fluid filled like space just behind the intraocular lens (IOL). Patient managed surgically by removal of the ‘IOL-capsule-complex’ with anterior vitrectomy. The microbiological culture report of ‘IOL-capsule-complex’ showed no bacterial growth. Visual rehabilitation was restored by implanting an anterior chamber lens 2 months afterwards.Conclusion: Though rare but delayed presentation of capsular block syndrome has reported but conventional treatment with Nd:YAG laser capsulotomy may have risk of intraocular infection spread. Extraction of ‘ IOL-capsulecomplex’ with anterior vitrectomy followed by late implanting an anterior chamber lens can restore the visual function and can lessen the risk of intraocular infection.

Anterior capsular phimosis is a well-known postoperative complication of cataract surgery, characterised by progressive constriction of the capsulorhexis opening due to fibrotic changes in the anterior capsule. We report a case of a 62-year-old male who presented with decreased vision in the left eye 6 weeks after undergoing cataract surgery with intraocular lens (IOL) implantation and capsular tension ring insertion. There was an oval-shaped anterior capsular phimosis with temporal haptic flexion of the IOL, along with posterior capsular opacification and wrinkling of the anterior capsule. Anterior segment optical coherence tomography (AS-OCT) showed a thick subcapsular fibrosis extending to the anterior surface after crossing the anterior capsular margin. Neodymium: yttrium-aluminum-garnet laser anterior capsular lysis was performed at four clock positions. One week after the procedure, exaggerated fibrosis was observed at the laser sites, which subsequently stabilised without any IOL decentration over a 4-month follow-up period. The final best-corrected visual acuity improved to 6/9. This case highlights anterior capsular phimosis, with AS-OCT imaging demonstrating subcapsular fibrosis that causes anterior capsule undulations and extends across the capsular edge onto the anterior capsule surface, along with the treatment response.

Dickkopf-1 inhibits Wnt3a-induced migration and epithelial-mesenchymal transition of human lens epithelial cells

Posterior capsular opacification (PCO) is a common long-term complication of cataract surgery. Intraocular lens design and material have been implicated in influencing the development of PCO. This study evaluated the association of hydrophobic and hydrophilic intraocular lenses on preventing PCO. Medline, Cochrane, EMBASE, and Google Scholar databases were searched until August 3, 2016, using the following search terms: cataract, posterior capsule opacification, and intraocular lens. Eligible studies included randomized controlled trials (RCTs), retrospective, and cohort studies. Eleven studies were included in the study with a total of 889 eyes/patients. The overall analysis revealed that hydrophobic intraocular lenses were associated with lower Nd:YAG laser capsulotomy rates than hydrophilic lenses [odds ratio (OR) = 0.38, 95% confidence interval (95% CI) = 0.16-0.91, P = .029]. Hydrophobic intraocular lenses were also associated with lower subjective PCO score (diff. in means: -1.32, 95% CI = -2.39 to -0.25, P = .015) and estimated PCO score (diff. in means: -2.23; 95% CI, -3.80 to -0.68, P = .005) as compared with hydrophilic lenses. Objective PCO score was similar between lens types. (diff. in means: -0.075; 95% CI, -0.18 to 0.035; P = .182). Pooled analysis found that visual acuity was similar between hydrophobic and hydrophilic intraocular lenses (diff. in means: -0.016; 95% CI, -0.041 to 0.009, P = .208). In general, PCO scores and the rate of Nd:YAG laser capsulotomy were influenced by intraocular lens biomaterial. Lens made of hydrophobic biomaterial were overall superior in lowering the PCO score and the Nd:YAG laser capsulotomy rate, but not visual acuity.

Background:This study performed to assess the safety of cataract extraction with phacoemulsification and intraocular lens (IOL) implantation in patients with high axial length compared with patients with normal axial length.Materials and Methods:A total of 866 eyes were enrolled in this study; all subjects underwent phacoemulsification and IOL implantation for treatment of cataract. Seven hundred and nine eyes fell in the normal group with axial lengths ranging between 21 and 24.5 mm, and 157 eyes were considered myopic with axial length equal or greater than 26 mm. The two groups were compared regarding intraoperative surgical complications, such as vitreous loss, posterior capsular rupture, nucleolus drop, and undesirable implantation of IOL in the anterior chamber.Results:Age was a risk factor in both groups, with each year increase of age, the chance of incidence of intraoperative complications increased 1.04-folds (P = 0.03). And with 1 mm increase in axial length, the incidence of complications raised 1.22-folds (P = 0.007). There was no significant correlation between axial length and incidence of vitreous loss, although the incidence of posterior capsular rupture and nucleus fragment drops increased with increment in the axial length. Sex of the patients and side of the left or right eye were not found to be significant risk factors.Conclusions:As the results illustrate, in this survey, age and high axial length were statistically significant risk factors for incidence of intraoperative complications of cataract surgery with phacoemulsification technique. Anticipation of these complications and also preparation and prophylactic measures may decrease incidence of these complications.

Intraoperative complications during cataract surgery, while uncommon, can significantly impact visual outcomes and identifying high-risk patients preoperatively improves surgical planning and supports personalized care. This study presents an early application of advanced machine learning (ML) models for predicting multiple intraoperative complications using routine preoperative data. We analyzed 3,957 cataract surgeries performed at a tertiary hospital and developed four ML models, XGBoost, Random Forest, CatBoost and TabPFN, to classify cases into three categories: no complications, posterior capsule rupture/vitreous loss and other complications. To address class imbalance due to the predominance of uncomplicated cases, random undersampling was applied during training. Model performance was assessed using area under the curve (AUC) and F1-score. SHAP (SHapley Additive exPlanations) analysis was used to interpret feature importance. TabPFN achieved the highest AUC score (0.62), followed closely by Random Forest and CatBoost (0.61 each), with Random Forest also demonstrating the highest F1-score (0.46). SHAP analysis highlighted age, tamsulosin use and surgeon experience as key predictors. This study provides a proof of concept for the feasibility of using machine learning for preoperative risk modeling of intraoperative complications in cataract surgery. While predictive performance was modest, validation on larger or external datasets is encouraged to further assess its potential role in surgical planning.

ABSTRACTPurpose: To assess the effect of posterior capsular opacification (PCO) and Neodymium-doped:Yttrium Aluminium Garnet (Nd:YAG) laser capsulotomy on tilt and decentration of intraocular lens (IOL) at vertical and horizontal meridians.Methods: The study included 64 eyes of 64 patients. IOL decentration and tilt were measured using a Scheimpflug camera before and 1 month after Nd:YAG capsulotomy. Corrected distance visual acuity (CDVA) and manifest refraction were also determined. Between-group differences of IOL position change and the effect of Nd:YAG laser capsulotomy were analyzed.Results: In the PCO group, before capsulotomy, CDVA was significantly lower than that after capsulotomy and of the control group values (p = 0.001 for both). No significant difference was observed in CDVA between the control group and the PCO group after capsulotomy (p = 0.854). Before capsulotomy, the angle of tilt and decentration at both meridians was significantly higher than that in the control group (tilt: p < 0.001; for both decentrations: p = 0.001, p = 0.003, respectively). A significant decrease was observed in the angle of tilt at both meridians (horizontal p = 0.001, vertical p = 0.001) from before to after capsulotomy in the PCO group. Although decentration was increased after capsulotomy, no significant position change was observed (horizontal p = 0.350, vertical p = 0.107). The angle of tilt and decentration at both meridians was significantly higher in the PCO group after capsulotomy compared to the control group (p < 0.001 for all).Conclusions: PCO is associated with not only axial displacement, but also tilt and decentration of IOL at the vertical and horizontal meridians. Laser capsulotomy decreased IOL tilt but had no effect on decentration. However, these changes did not significantly change the visual acuity between the control group and the PCO group after capsulotomy.

Objective To evaluate the effect of posterior capsular opacification and Nd∶YAG laser capsulotomy on the accommodative function of the 1CU accommodative intraocular lens (1CU AIOL).Methods This was a retrospective study.Twenty patients (24 eyes) with posterior capsular opacification after phacoemulsification and implantation of an 1CU AIOL were included in the study.Uncorrected distance visual acuity,best corrected distance visual acuity (5 m),distance corrected intermediate visual acuity (50 cm),distance corrected near visual acuity (33 cm),and amplitude of accommodation with subjective techniques of near point and defocusing were measured at 3 months after ICU AIOL surgery,1 day before Nd∶YAG laser capsulotomy and 3 months after Nd∶YAG laser capsulotomy.All data were statistically analyzed with repeated measure analysis of variance (ANOVA).Results Compared to 3 months after ICU AIOL surgery,uncorrected distance visual acuity (F=108.87,P＜0.01),best corrected distance visual acuity (5 m) (F=116.97,P＜0.01),distance corrected intermediate visual acuity (50 cm) (F=79.89,P＜0.01),distance corrected near visual acuity (33 cm) (F=118.84,P＜0.01),and amplitude of accommodation (F=81.78,P＜0.01)with subjective techniques of near point and defocusing had all decreased at 1 day before Nd∶YAG laser capsulotomy,and had increased by 3 months after Nd∶YAG laser capsulotomy.The differences were statistically significant.There was no statistically significant difference between the two methods for measuring amplitudes of accommodation (F=0.272,P＞0.05).Conclusion Conclusion The accommodative function of the 1CU AIOL had obviously decreased because of the presence of posterior capsular opacification and recovered after Nd∶YAG laser capsulotomy 3 months after surgery. Key words: Posterior capsular opacification; Capsulotomy; Intraocular lens,accommodative

Aim: To evaluate demographic characteristics, intraoperative problems and postoperative complications of cataract surgery in patients with pseudoexfoliation (PEX) syndrome Material and Method: The files of patients who underwent cataract surgery in the last 1 year were retrospectively scanned and 147 eyes of 130 patients with PEX were included. Examination findings were obtained from medical records retrospectively with information on surgery and postoperative follow-up information. Patients were divided into 2 groups with and without PEX. Preoperative and postoperative visual acuities, intraocular pressure(IOP), pupil dilatation, presence of zone weakness, intraoperative and postoperative complications, and patients with and without glaucoma were noted separately. Results: Among the patients included in the study were 71 men (54.6%) and 59 women (45.4%). The mean age man was 68,62 ± 8,04 the mean age of women was 67,84 ± 9,64 for females. There was an increase in visual acuity in both groups when compared with the best corrected visual acuity before and after surgery (p<0.001). The postoperative IOP values of the patients were significantly higher statistically significantly lower than preoperative values (p<0.001). The most common preoperative problem was weak dilatation of the pupil, which was 81.75% (n: 112) in all eyes. Conclusion: There are many factors that complicate cataract surgery in patients with PEX, and surgeons should be aware of the potential complications of cataract surgery in these patients.

BackgroundCataract is the leading cause of blindness globally, particularly in India. Despite advancements in surgical techniques, postoperative complications remain common, with posterior capsular opacification (PCO) being the most frequent issue. Although neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy is recommended for managing PCO, it is associated with various side effects. This study aimed to evaluate the effects of Nd:YAG laser capsulotomy on intraocular pressure (IOP), visual acuity, anterior chamber depth (ACD), macular thickness, and corneal endothelium in Indian patients.MethodologyThis prospective, hospital-based study was conducted in the ophthalmology department at a tertiary care center in western Maharashtra from September 2022 to June 2024. Approval from the Institutional Scientific and Ethics Committee was obtained before commencing the research. In the study, 72 eyes from 72 patients with PCO following uncomplicated cataract surgery who were undergoing Nd:YAG laser capsulotomy were included, whereas patients with corneal pathology, retinal pathology, complicated cataract surgery, or trauma were excluded. Patients with active uveitis, non-compliant patients, and those unwilling to undergo the procedure were also excluded. Written informed consent was obtained from each patient. Data were managed in Microsoft Excel, and statistical analysis was conducted using the SPSS 26.0 software. As the continuous variables exhibited skewed distribution, the Wilcoxon test was employed to assess categorical variables such as the significance of IOP and endothelial cell differences over time. A significance level of 5% was assumed, with a p-value below 0.05 considered significant.ResultsThe mean age of patients who underwent Nd:YAG capsulotomy was 64 years, with a female predominance of 37 (51.4%). In the study, 37 (51.4%) patients had their left eye treated, while 35 (48.6%) had their right eye treated. Overall, 45 (62.5%) patients had a baseline best-corrected visual acuity (BCVA) of 6/24-6/12. At one hour post-procedure, 46 (63.9%) patients in Group II had a BCVA of 6/24-6/12, and by one week after treatment, 53 (73.6%) patients had a BCVA of >6/12-6/6. ACD was normal in all patients before and after the procedure. Two patients developed macular edema at one hour and one week after the procedure. The mean IOP at baseline, one hour, and one week were 13.5, 13.86, and 13.69 mmHg, respectively. A significant increase in IOP was observed at one hour post-procedure, along with a significant decrease in endothelial cell count compared to baseline, which also persisted at one week.ConclusionsPatients undergoing Nd:YAG capsulotomy experienced an initial rise in IOP, followed by a subsequent decline. Improved visual acuity was noted in most patients at one hour and by one week. A significant decline in endothelial cell count was observed following the procedure, and macular edema was noted in two patients. Anterior chamber reaction was observed in nearly all patients, which decreased by one week. With no change in ACD following the procedure up to one week, ocular refraction was not significantly impacted in the short term. Therefore, further large-scale intervention studies are needed to evaluate the effects of Nd:YAG laser capsulotomy size and the energy used on refractive error and post-procedure complications, as well as to explore the long-term effects on IOP.

Introduction: High myopia is a risk factor for cataract formation. A relationship between myopia and higher complications in cataract surgeries has long been suggested. Materials and methods: After obtaining ethics committee clearance, this cross-sectional, case-control observational study was conducted in 100 participants of age above 18 years. They underwent cataract surgery. Participants were divided into two groups:- Group A & B - Participants with axial length between 21 and 26 mm and more than 26 mm respectively. Results and discussion: This shift of myopic individuals undergoing cataract surgery at an earlier age was found to be statistically significant. There was a statistically significant association between increasing age and PCR. Most common type of cataract in group A is cortical (30.8%) followed by nuclear (28.8%). Most common type of cataract in a group B is PSC (50%) followed by nuclear (22.9%). There was no statistical association between type of cataract and any complication. Conclusions: Intraoperative complications of cataract surgery do not increase significantly with increase in axial length. Myopic individuals are prone to develop cataracts earlier. NS and PSC type of cataracts are more common compared to cortical type of cataracts in emmetropic individuals.

Congenital cataract has a high amblyogenic potential and is an important subject in pediatric opthalmology. Because of amblyopia risk, congenital cataracts require an early diagnosis.Bilateral congenital cataract is genetic in at least 25% of cases. In contrast, unilateral congenital cataract is usually sporadic. The mode of inheritance is mostly autosomal dominant but autosomal recessive and X-linked modes also occur. Metabolic cataract may be diagnosed biochemically. Because of the anatomical dimensions being smaller and the tissue structures being softer and more elastic in the young patient, surgery of paediatric cataracts represents a special challenge for the ophthalmic surgeon. The evolution of paediatric cataract surgery continues, with many adult cataract surgical techniques being applied to children with minor technical adjustments. Intraocular lenses have helped to provide better anatomic and functional outcome for cataract surgery in children. More and more, surgeons are implanting intraocular lenses in younger children. One of the most widely reported technologic advances in 2004-2005 was the use of hydrofobic acrylic intraocular lenses in children. Predicting axial growth, and refractive change that accompanies it, is one of the major remaining challances for the long- term care of children who have had cataract surgery. Due to the increased inflammatory reaction postoperatively, a minimally traumatic operation, intensive occlusion therapy and optimal correction with glasses or contact lenses are also necessary. Orthoptic follow-up examinations are also important for the long-term result.In this review, a short information about diagnosis and management of congenital cataract is presented.

This article surveys the literature from 2002 and 2003 and addresses a variety of complications that may arise during cataract surgery. Modern surgical techniques and technology contribute to the decreased incidence of complications. Surgeon experience, early recognition of potential complications, and optimal handling of events lead to better outcomes. Recognizing eyes preoperatively that are particularly at risk for having dysgenesis of the capsular bag, cortical-capsular adhesions, low endothelial cell reserve, dropped nucleus, and bag-lens dislocation will allow for contingency planning and appropriate tailoring of techniques. Capsular tension rings are indispensable for achieving in-the-bag implantation in the presence of weak zonules and zonulolysis. Viscolevitation to rescue sinking implants, avoidance of foldable lens complications, and proper lens placement with an open capsule are discussed. High-frequency ultrasound biomicroscopy is a useful diagnostic tool. Noninjection sub-Tenon anesthesia is not benign. Complications have been documented that include traumatic optic neuropathy. Immediate diagnosis and a trial of corticosteroids could be vision saving. Mastering topical anesthesia is a worthy goal. In some cases, faulty instruments result in complications. Routine inspection of reusable instruments, or the use of disposable instruments is warranted. Though there is no FDA-recognized use, at the time of this writing, for trypan blue dye, it has become the world standard for intraocular staining because of its safety and efficacy. Clear corneal self-sealing incisions are increasingly mainstream and, when properly constructed, are extremely secure. The most significant trend for successful management of intraoperative complications this year is the increasing use of pars plana anterior vitrectomy. The ability to identify prolapsed vitreous by intracameral Kenalog staining is an invaluable tool. Surgeons depend on a team of nurses and technicians for optimal outcomes. With new technology and techniques highlighted by capsular tension rings, Kenalog vitreous identification, and fourth-generation fluoroquinolones, even complicated cataract surgery can result in optimal outcomes.

Congenital cataract is a rare eye disease, one of the leading treatable causes of low vision in children worldwide. Hereditary cataracts can be divided in syndromic and non-syndromic cataracts. Early diagnosis in congenital cataracts is key to reach good visual function. Current surgical techniques, that combine microincision cataract extraction and primary intraocular lens (IOL) implantation, have improved childhood cataract outcome. Complications include posterior capsule opacification (PCO), aphakic or pseudophakic glaucoma, uveitis, pupil displacement and IOL decentration. A recent study using a modified Delphi approach identified areas of consensus and disagreement in the management of pediatric cataract. A consensus or near consensus was achieved for 79% of the questions, however 21% of the questions remained controversial, as for IOL implantation strategy. Congenital cataracts show a highly variable phenotype and genotype, and can be related to different mutations, genetic variance, and other risk factors. Congenital cataracts can be associated with other ocular developmental abnormalities, including microphthalmia, microcornea, or aniridia and with systemic findings. Next-generation sequencing (NGS) and forthcoming new ultra-high-throughput sequencing represent excellent tools to investigate the genetic causes of congenital cataracts. A better recognition of different clinical presentations and underlying etiologies of congenital cataracts may lead to the development of new approaches to improve visual outcome after cataract surgery and promote early detection of systemic associated syndromes.

Background: Neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy is a relatively noninvasive procedure that is used in the treatment of posterior capsular opacification (PCO). PCO is caused by proliferation of lens epithelial cells which causes fibrotic changes and wrinkling of the posterior capsule and results in decreased vision, glare, and other symptoms similar to that of the original cataract. Objective: To find out the visual outcome after performing Nd:YAG laser capsulotomy for PCO. Materials and method: A prospective clinical trial was carried out in National Institute of Ophthalmology (NIO), Dhaka, Bangladesh from January 2010 to June 2011 on purposively selected 70 adult subjects of both sexes who developed PCO within 2 months to more than 2 years after extracapsular cataract extraction with posterior chamber intra ocular lens implant. After thorough pre laser assessment Nd:YAG laser capsulotomy was carried out with Zeis VISULAS YAG II through Zeiss slit lamp under topical anesthesia. Data were recorded and expressed as proportion. Results: Out of the 70 subjects 40 were male and 30 were female. The average time interval of cataract surgery and Nd: YAG laser capsulotomy was 23 months. Capsular fibrosis (57.04%) was the predominant type of PCO. The pre laser visual acuity (VA) of more than 61.06% of eyes was 6/36 or below while 41.12% had VA hand movements to finger count. After Nd:YAG laser capsulotomy VA of 6/18 or better was achieved in 63.9% of eyes while 9.94% recovered to 6/9 and 11.36% achieved 6/6. None of these eyes showed further deterioration in VA. Conclusion: Nd:YAG laser capsulotomy for PCO is safe, effective and a rewarding procedure for improvement of vision.DOI: http://dx.doi.org/10.3329/dmcj.v1i1.14971 Delta Med Col J. Jan 2013;1(1):16-19